Wrist Fracture question

[kb1234]

Hi All,

I have a case study to do which states: "A young college student arrives in the emergency department holding his arm close to his body. His wrist is obviously misshapen, but swelling is minimal. He tells you he was playing basketball with friends an hit the gym wall after running toward the goal for a lay-up shot. He complains of pain with attempted flexion or rotation of the wrist. A radiograph confirms a wrist fracture, and cast application is planned."

The question I have is: What intervention should receive priority?

I believe it's Immobilization???? but my med-surge book has one paragraph on wrist fractures which explains nothing, CAN ANYONE HELP, PLEASE

[LouisVRN, RN]

Are you talking about nursing interventions? If so I don't think immobilization fits, that's a medical intervention. As far as nursing interventions go I would think, knowledge deficit, potential for ineffective tissue perfusion or pain management would be top.

[kb1234]

Yes Louis, I was talking about the priority Nursing Intervention for that case. Knowledge deficit, potential for ineffective tissue perfusion or pain would be the Nanda Diagnosis but I would still have to state what the priority nursing interventions would be for that patient??? That's where I'm a little confused of what is priority....

[netglow, ASN, RN]

Hint, which of these would apply A, B, or C? (abc's)

[PAROPPY, BSN, RN]

I was just trying to look this up for you in my NAON core cirriculum book and they were pretty vague on nursing interventions for wrist fractures specifically but this is what I got:

Immoblization, analgesia, assessment for peripheral pulses, and elevation to at least the level of the heart (there may be some contraindications for elevation above the heart). Also, anxiety relief for the patient and giving clear, easy to understand, factual info about procedures. Hope this helps!

[LouisVRN, RN]

Using, the ABC method, obviously the only one applicable would be C. Therefore elevate to the level of the heart, provide pillows for comfort, check capillary refill, pulses, sensations (does he have any numbness, tingling?), provide ice if okay'd by ortho. Therefore your priority nursing diagnosis would be potential for ineffective tissue perfusion. Hope that helps.

[shiccy]

Please remember folks that when you are doing things in nursing the ABC model is *not* always the definite go-to - the NCLEX review I took taught me that one.

As far as what I'd do first, it'd probably be immobilization, pain, circulation, elevation.

[bunsterj]

what would you not elevate above the level of the heart?

[shiccy]

what would you not elevate above the level of the heart?

put it on some pillows to bring it to head level. keeps bad spirits away from the swelling. also decreases possible vascular / neuro issues from said swelling.

[crystalchen]

I am thinking about pain management because a fracture is a lot of pain....... effective pain management will also stablize the patient for future interventions.